Retrospective Comparison of the Effects of Intrathecal Morphine and Erector Spinae Plane Block on Postoperative Analgesia in Patients Undergoing VATS

Objectives: This study evaluates the analgesic effects of intrathecal morphine (ITM) and ultrasound-guided erector spinae plane block (ESPB) in managing postoperative pain following video-assisted thoracoscopic surgery (VATS).
Methods: This retrospective observational study examined hospital records and anesthesia documents of 40 patients who underwent VATS at a university hospital between January 2021 and January 2022. The patients were divided into two groups: ITM and ESPB. The comparative analysis included cumulative morphine consumption within the initial 12/24 h after VATS, Numeric Rating Scale (NRS) resting/activity scores, rescue analgesic requirements, and the side effect profile.
Results: During the first 12 h postoperatively, the ITM group exhibited lower median morphine consumption than the ESPB group (ITM: 1.9 mg [0.85–3] vs. ESPB: 3.65 mg [3–4.23], p=0.003). Further, within the initial 24 h postoperatively, the ITM group also exhibited lower median morphine consumption compared to ESPB (ITM: 4 mg [1.54–5.38] vs. ESPB: 10 mg [10–10], p<0.001). The NRS resting/activity scores were consistently lower in the ITM group than in the ESPB group at all measurement times (p<0.001). The number of patients receiving rescue analgesic medication was lower in the ITM group than in the ESPB group (ITM, n=6 [30%] vs. ESPB, n=20 [100%]; p<0.001). The side effect profiles of both groups were comparable.
Conclusion: ITM reduced morphine consumption, pain scores, and the requirement for rescue analgesia compared with ESPB, with a comparable side effect profile after VATS.